FLUDARABINE IS AN EFFECTIVE AGENT IN IMMUNOCYTIC LYMPHOMA

Background: Fludarabine monophosphate is a new adenine nucleoside anal ogue with promising efficacy in Waldenstrom's macroglobulinemia with r esponse rates of 31-45% in previously treated and up to 100% in previo usly untreated patients.Patients and Methods: In this paper we report on the clinical experience with fludarabine and its side effects in 9 patients with advanced or refractory immunocytic lymphoma including 5 patients with Waldenstrom's macroglobulinemia. Fludarabine was adminis tered at a dosage of 25 mg/m(2) daily for 5 days as a 30-minute, intra venous infusion. This course was repeated every 5th week. Results: 1/9 patients achieved complete remission, and 6/9 achieved partial remiss ion (PR): 1/9 had stable disease and 1/9 was progressive. The median r emission duration until relapse or death was 7.4 months, Most response s to fludarabine occurred within 2 treatment courses. Major toxic effe cts included lethal infections in 2 patients. Both patients were in PR at time of developing infections, one Pneumocystis carinii pneumonia and one septicemia The occurrence of even opportunistic infections may be due not only to hypogammaglobulinemia or fludarabine-induced granu locytopenia, but also to a remarkable decrease of CD4(+) cells during fludarabine therapy. Conclusion: It is concluded that fludarabine is a n effective agent in patients with advanced immunocytic lymphoma. Howe ver, fludarabine has a remarkable suppressive effect on T-lymphocytes, in particular on CD4(+) lymphocytes, especially in pretreated patient s.